| NPI | 1720172687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN MD0000041913) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA md00046130) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 054643) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-08-21 |